Chapter5NotesStandardsofCare

I.
DefinitionofStandardsofCare
a. Standardsofcare:levelordegreeofqualityconsideredadequatebyagivenprofession
i. Minimalrequirements(knowledgeandskills)toexercisereasonablecarethatdoesnotcauseunnecessary
harmtopatients
b. Basicpurposeofstandardofcareprotectandsafeguardpublicasawhole
i. Ifnostandardconsumerwouldopenupselftovaryinglevels/qualityofcare
c. Differentthanobjectives(goalsthatgivedirectiontowhatmustbeaccomplished),philosophies(whyanactionis
performed)andguidelines(describerecommendedcoursesofaction)
d. Standardofcareareauthoritativestatementspromulgatedbyaprofessionbywhichqualityofpractice,serviceor
educationcanbeevaluated
II.
Establishmentofnursingstandardsofcare
a. Internalstandards
i. Standardssetbytheroleandeducationofthenurseorbytheindividualinstitution
1. Nursesjobdescription,levelofeducationandexpertiseaswellasaninstitutionspoliciesand
procedures
ii. Policiesdonthavetobeinwritingtobeconsideredlegallyenforceable
1. However,unwrittenpoliciesmaypotentiatealiability
b. Externalstandards
i. Standardssetbythestateboardofnursing,professionalorganizations,specialtynursingorganizations,
currentnursingliterature,federalorganizationsandfederalguidelines
1. Areexternalsincetheytranscendindividualpractitionersandsingleinstitutions
ii. Stateboardsofnursingpublishstandardsinstatenursepracticeactorinrules/regulations
1. Haveforceoflaw
iii. Professionalorganizationsaddtoacceptablestandardsofcareforprofessionalnursing
1. Ex:AmericanNursesAssociation(8standards),NationalLeagueforNursingAccrediting
Commission(qualityofnursingeducation+accreditsschools,anarmoftheNationalLeagueof
Nursing
iv. Federalorganizations/guidelines
1. Ex:TheJointCommissionsetsnursingstandardsbypublishingComprehensiveAccreditation
ManualforHospitals
v. NursingLiterature
1. Journalarticlesandtextbooks
a. Mayhavestandardsforspecificcases,ifRNsdonotfollowcanbeheldliable
III.
Nationalandlocalstandardsofcare
a. Nationalstandardsarebasedonreasonablenessandaretheaveragedegreeofskill,careanddiligenceexercisedby
membersofthesameprofession
b. Nationalstandardsareimportantbecause
i. Allareasofhealthcaredeliverysystemshaveaccesstothesameinformationandeducationalopportunities
ii. Allpatientshaverighttoqualityhealthcarewhethertheyareinaruraltownoracity
IV.
ImportanceofStandardsofcaretotheindividualnurse
a. Standardsofcarearereferencedinmalpracticecasesagainstnursestoshowthattheybreachedthedutyofcare
owedtothepatients
i. Dutyofcare:applicablestandardofcare
ii. whatwouldareasonable,prudentnursewithlikeexperience/educationdoundersimilarconditionsinthe
samecommunity?
b. WhencourtsdecidewhichstandardsofcareapplytotheRNssituationtheyconsider
i. Errorinjudgmentrule
1. Allowscourttoevaluatethestandardsofcaregivenapatienteveniftherewasanhonesterrorin
judgment,includinganerrorindiagnosis
a. Whatthecourtevaluatesisthecaregivenandwhetherthatthecaremettheprevailing
standardsnotwhetherthejudgmentwascorrect
ii. Twoschoolofthoughtdoctrine
1. Supportsthenursewhochoosesamongalternativemeansofdeliveringqualityhealthcare
2. Courtevaluatesthestandardofcaregivenwhenthenursechoosesamongalternativemodesof
treatment
a. Werethestandardsofcaremetinthatchosenmodeoftreatment?
b. Ifyescourtsupportsthatqualityofcarewasgivenevenifothernursesmayhavechosen
adifferentapproach

V.

VI.

Guidelines
a. Standardsofcare
i. Allprofessionshavestandardsofcare.StandardsofcarearetheMINIMUMlevelofacceptablecare.Can
givehigherlevelofcarebutMINIMUMmustalwaysbemet.
ii. Standardsofcarecanbesetinternally(Individuals)orexternally(allnurses)
iii. Standardsofcarefoundin
1. Statenursepracticeact
2. Publishedstandardsofprofessionalorganizations
3. Federalagencyguidelines/regulations
4. Hospitalpolicy/proceduremanual
5. Individualnursejobdescription
6. Manufacturerspublishedmaterials
7. Inservicefilms/materials
iv. RNisaccountabletomeetstandardsofcare.
v. Standardsofcarearedeterminedforjudicialsystembyexpertwitnesses
b. Standardsofcarecanbeusedtodeterminewhethertherehasbeenviolationofpersonsconstitutionalrightsor
providecriterionforplacingnursingpracticeonaprofessionallevel
Ethicalissuesandstandardsofcare
a. Standardsofcarearefluidanddynamic
b. Onewaytheprofessionassuresthatpractionersmeetcurrentstandardsofcareisbycreatingpolicy/procedure
manualsthatareregularlyreviewedforcurrencyandappropriatenesswhilemakingsuretheyarenotoverwhelming
fortheproviderstoimplement
c. Majorethicalissueconcern
i. Ethicaldilemmaofbeinganexpertwitnessinaddressingstandardsofcare
1. Ifrecordsshowinterventionswereinappropriateorthatstandardsofcarewasnotmet
a. Whatobligationdoestheexpertwitnesshavetodisclosesuchfindingstotheattorney
representingthedefendants
b. Howdoesoneexplainoutcomesthatdoesnotcreateliabilityorprejudicethepatient